Provider Demographics
NPI:1972116804
Name:ABRAHAM, MAYA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:MARIE
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:MARIE
Other - Last Name:WERKSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:61 DELANO ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:NY
Mailing Address - Zip Code:13142-1400
Mailing Address - Country:US
Mailing Address - Phone:315-298-6564
Mailing Address - Fax:315-298-7488
Practice Address - Street 1:3045 EAST AVE STE G400
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036-2611
Practice Address - Country:US
Practice Address - Phone:315-675-9200
Practice Address - Fax:315-630-3168
Is Sole Proprietor?:No
Enumeration Date:2020-08-29
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF346156-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily